Objective The aim of this multicentric cross‐sectional study was to examine the permanency of Montgomery thyroplasty ( MTIS ) results from a patient's perspective. Design The study consisted of collecting Voice Handicap Index ( VHI ‐30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long‐term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow‐up were also analysed. Setting Multicentric study involving three tertiary European voice centres. Participants Forty‐nine unilateral vocal fold paralysis ( UVFP ) patients, treated by MTIS , were included in the study. Main outcome measures The Voice Handicap Index‐30 score. Results & Conclusions The median VHI was significantly different over time‐points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time‐points (median VHI : 70 vs 21, respectively; P < .001) and between preoperative and very long‐term postoperative time‐points (median VHI : 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long‐term postoperative time‐points (median VHI : 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow‐up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS , in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.

Clinical OtolaryngologyVolume 43, Issue 1 p. 340-343 CORRESPONDENCE: OUR EXPERIENCE Posterior cordotomy in bilateral vocal cord paralysis using monopolar microelectrodes and radiofrequency in 18 patient J. Basterra, Corresponding Author J. Basterra jorge.basterra@uv.es orcid.org/0000-0002-8939-6317 ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, Spain Correspondence J. Basterra, ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, Spain. Email: jorge.basterra@uv.esSearch for more papers by this authorY. Castillo-Lopez, Y. Castillo-Lopez ENT Unit, Centro Medico Nacional de Occidente, IMSS, Mexico City, MexicoSearch for more papers by this authorR. Reboll, R. Reboll ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorE. Zapater, E. Zapater ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorC. Olavarria, C. Olavarria ENT Unit, Surgical Department, Clinica Santa Maria, University Clinic Hospital of Chile, Santiago, ChileSearch for more papers by this authorF. Krause, F. Krause ENT Unit, Surgical Department, Clinica Los Condes, Santiago Militar Hospital, Santiago, ChileSearch for more papers by this authorR. Hernandez, R. Hernandez ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorM. Torres, M. Torres ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorF. Tocornal, F. Tocornal ENT Unit, Surgical Department, Clinica Los Condes, Santiago Militar Hospital, Santiago, ChileSearch for more papers by this author J. Basterra, Corresponding Author J. Basterra jorge.basterra@uv.es orcid.org/0000-0002-8939-6317 ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, Spain Correspondence J. Basterra, ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, Spain. Email: jorge.basterra@uv.esSearch for more papers by this authorY. Castillo-Lopez, Y. Castillo-Lopez ENT Unit, Centro Medico Nacional de Occidente, IMSS, Mexico City, MexicoSearch for more papers by this authorR. Reboll, R. Reboll ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorE. Zapater, E. Zapater ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorC. Olavarria, C. Olavarria ENT Unit, Surgical Department, Clinica Santa Maria, University Clinic Hospital of Chile, Santiago, ChileSearch for more papers by this authorF. Krause, F. Krause ENT Unit, Surgical Department, Clinica Los Condes, Santiago Militar Hospital, Santiago, ChileSearch for more papers by this authorR. Hernandez, R. Hernandez ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorM. Torres, M. Torres ENT Unit, Surgical Department, Valencia Medical School, University General Hospital, University of Valencia, Valencia, SpainSearch for more papers by this authorF. Tocornal, F. Tocornal ENT Unit, Surgical Department, Clinica Los Condes, Santiago Militar Hospital, Santiago, ChileSearch for more papers by this author First published: 17 July 2017 https://doi.org/10.1111/coa.12940Citations: 4 Meetings at which parts of this manuscript were presented: 85th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery, Dortmund, Germany, 28 May-1 June, 2014; 87th Annual Meeting of the German Society of Oto-Rhino-Laryngology Head and Neck Surgery, Düsseldorf, Germany, 4-7 May, 2016. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume43, Issue1February 2018Pages 340-343 RelatedInformation

Objective: Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients.Methods: Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma.Results: Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology).Conclusion: Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

Martín, A.1; Granell, M.1; Pallardó, M.Á.1; Tornero, F.1; Zapater, E.2; De Andrés, J.3 Author Information

Tornero, F.1; Martín, A.1; Pallardó, M. A.1; Granell, M.1; Zapater, E.2; De Andrés, J.1 Author Information

Clinical OtolaryngologyVolume 36, Issue 5 p. 500-504 CORRESPONDENCE: HOW WE DO IT Eighty-three cases of glottic and supraglottic carcinomas (stage T1-T2-T3) treated with transoral microelectrode surgery: how we do it J. Basterra, J. Basterra Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this authorR. Reboll, R. Reboll Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this authorE. Zapater, E. Zapater Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this author J. Basterra, J. Basterra Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this authorR. Reboll, R. Reboll Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this authorE. Zapater, E. Zapater Valencia Medical School, University of Valencia ENT Department, Valencia University General Hospital, Valencia, SpainSearch for more papers by this author First published: 28 October 2011 https://doi.org/10.1111/j.1749-4486.2011.02336.xCitations: 5 Professor J. Basterra, Plaza de la Legión Española 4, 46010 Valencia, Spain. Tel.: 011 34-96 3615641; Fax: 011 34-963864805; e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Basterra J, Zapater E, Moreno R et al. (2006) Electrosurgical endoscopic cordectomy with microdissection electrodes: a comparative study with CO2 laser. J. Laryngol. Otol. 120, 661–664 2 Basterra J, Frias S, Alba J et al. (2006) A new device for treating laryngeal carcinoma using microdissection electrodes. Laryngoscope 116, 2232–2234 3 Basterra J, Alba JR, Bonet M et al. (2010) Endoscopic resection of supraglottic (T1-T2-T3) and glottic (T2-T3) carcinomas using microdissection electrodes. Otolaryngol. Head Neck Surg. 142, 449–451 4 Basterra J, Frias S, Alba JR et al. (2006) Comparative study of acute tissue damage induced by the CO2 laser versus microelectrodes in cordectomies. Otolaryngol. Head Neck Surg. 135, 933–936 5 Zapater E, Frias S, Perez A et al. (2009) Comparative study on chronic tissue damage after cordectomies using Either a CO2 laser or microdissection electrodes. Head Neck 31, 1477–1481 6 Remacle M, Eckel H, Antonelli A et al. (2002) Endoscopic cordectomy. A proposal for classification by the Working Committee. European Laryngological Society. Eur. Arch. Otorhinolaryngol. 257, 227–231 7 Motta G, Esposito E, Testa D et al. (2004) CO2 laser treatment of supraglottic cancer. Head Neck 26, 442–446 8 Agrawal A, Moon J & Davis K (2007) Transoral carbon dioxide laser supraglottic laryngectomy and irradiation in stage I, II and III squamous cell carcinoma of the supraglottic larynx. Arch. Otolaryngol. Head Neck Surg. 133, 1044–1050 9 Rigby MH & Taylor SM (2007) Endoscopic treatment of cis-T2 glottic cancer with a CO2 laser: preliminary results from a Canadian centre. J. Otolaryngol. 36, 106–110 10 Rucci L, Romagnoli P & Scala J (2010) CO2 laser therapy in Tis and T1 glottic cancer: indications and results. Head Neck 32, 392–398 Citing Literature Volume36, Issue5October 2011Pages 500-504 ReferencesRelatedInformation

Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck area. They are classically divided into two subgroups, Hodgkin's lymphomas (HLs) and non-Hodgkin's lymphomas (NHLs). We describe the clinical characteristics of head and neck lymphomas and the methods to establish the diagnosis. The World Health Organization classification of lymphoid tissues describes more than 50 different histological types, and we analyse the most common staging system for lymphomas, the Ann Arbor staging system. Finally, the different therapeutic approaches are discussed.

Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck area. They are classically divided into two subgroups, Hodgkin's lymphomas (HLs) and non-Hodgkin's lymphomas (NHLs). We describe the clinical characteristics of head and neck lymphomas and the methods to establish the diagnosis. The World Health Organization classification of lymphoid tissues describes more than 50 different histological types, and we analyse the most common staging system for lymphomas, the Ann Arbor staging system. Finally, the different therapeutic approaches are discussed.

e17032 Background: In cancer, systematic analysis of mRNA expression levels can contribute to define a molecular network of lung carcinogenesis and establish predictive and prognostic molecular markers. Altered mRNA expression in certain angiogenic and anti-angiogenic genes such as vascular endothelial growth factor family of ligands and their receptors together with other molecules implicated in angiogenesis could predict disease outcome and add prognostic information at diagnosis. Methods: We performed RT-qPCR in frozen head and neck cancer specimens from untreated patients who had undergone surgical resection (n = 23). Samples were processed for mRNA extraction following standard procedures and quantification of gene expression was expressed as relative concentration normalized by an endogenous gene. The following angiogenic genes were quantified: PDGF-A, PlGF, VEGF-A, VEGF-B, VEGF-C, VEGF-D, COX-2, bFGF, HGF, IL-8; and anti-angiogenic genes: Angiomotin and endostatin. Results: Median age was 56.5 years, range (31–79), 17 patients presented squamous carcinoma of the larynx; 8 patients were stage III and the other 15 stage IV. None of the patients received pre-surgery chemo or radiotherapy and 10 patients reveived post-surgery treatment. Our results show that tumor samples had significant higher expression of PDGF, PlGF, COX-2, and IL-8 and a deep down-regulation of angiomotin. However, those data show no correlation between the levels of expression and stage of the disease. Conclusions: Our results reveal that there is an increase in the expression of the pro-angiogenic mediators PDGF, PlGF, COX-2, and IL-8 and a downregulation of angiomotin that may mediate the inhibitory effect of angiostatin on tube formation and the migration of endothelial cells toward growth factors during the formation of new blood vessels in the tumoral area. This data suggest that more research are needed in other angiogenic mediators that VEGF, that PlGF and angiomotin have some role in cancer progression and could be a promising new biomarker in head and neck cancer. No significant financial relationships to disclose.

OBJECTIVE:Occasionally, after performing a cordectomy to treat a T1 glottic tumor, the pathologist does not detect carcinomatous cells in the surgical specimen. This study determined how often this happens and analyzed these cases to identify related variables.METHODS:Forty-six patients were studied. Data on patient age and gender, tumor T stage and macroscopic surface extension, device used (laser vs. microelectrode dissection (ME)), and presence/absence of a negative cordectomy were compiled. We performed excisional biopsies as a diagnostic procedure.RESULTS:Tumor stage was carcinoma in situ (Cis; 11 cases), T1a (28 cases), or T1b (7 cases). Nineteen tumors were limited, and 27 were extensive. Twenty-one patients underwent laser surgery, and 25 had ME. There were 12, 21, 4, and 9 types II to V cordectomies, respectively. The pathologist reported 15 negative cordectomies (32.6%). Only tumor extension was significantly associated with a negative cordectomy (p=0.047).CONCLUSION:In 32.6% of our cases, the excisional biopsy was diagnostic and therapeutic. This percentage rose to 52.6% in the cases of limited tumors. We recommend performing an excisional biopsy and limited resection of the surgical bed with ME or laser surgery. A pathologist can examine the margins to determine whether the resection should be extended. When choosing radiotherapy, it is better to first perform an incisional biopsy to obtain a diagnosis of carcinoma.

Conclusions. The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques. Objectives. To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy. Patients and methods. A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps. Results. In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.

Microdissection electrodes (MEs) have previously been used to perform endoscopic cordectomies. We designed a prospective study in order to compare the ME with the CO2 laser technique. Over two years, 20 patients with T1 glottic carcinoma were operated on with CO2 laser and 20 with MEs. The device was chosen alternatively for each new patient. Two patients in both treatment groups had slight glottic incompetence. Three patients in each group showed web formation. The only granuloma was observed in a CO2 laser patient. Seven of the ME patients developed slight dysphonia, 10 developed medium grade dysphonia and three developed severe dysphonia. Seven of the CO2 laser patients developed slight dysphonia, seven developed medium grade dysphonia and six developed severe dysphonia. No statistically significant differences were observed on comparing the grade of dysphonia with patient age, T stage, type of cordectomy or surgical device. We consider the ME to be a useful and inexpensive alternative to CO2 laser.

El tratamiento con radioterapia en el cáncer de cabeza y cuello es una causa de hipotiroidismo. Nos proponemos estudiar el desarrollo de hipofunción tiroidea en estos pacientes. Se realizó un análisis retrospectivo de 194 pacientes tratados con radioterapia por cáncer de cabeza y cuello. Se determinó la tirotropina (TSH) y la tiroxina (T4) libre a los 3, los 6 y los 12 meses después de la radioterapia y anualmente durante el seguimiento. El hipotiroidismo se clasificó como subclínico (aumento de la TSH y la T4 libre normal) y clínico (aumento de la TSH y disminución de la T4 libre). Se analizó la relación del hipotiroidismo con edad, sexo, estirpe histological del tumor, dosis de radiación y el uso de quimioterapia. Con una media de seguimiento de 4,2 años, 56 pacientes presentaron elevación de la TSH (39 pacientes subclínico y 17 clínico). El tiempo medio para el diagnóstico fue de 3,0 ± 1,8 años (subclínico 2,6 ± 1,5 años, clínico 4 ± 1,9 años; p < 0,05). El 80% de los pacientes fueron diagnosticados entre el segundo y el sexto año desde la radioterapia. La edad, la histología del tumor, la dosis de radiación y el uso de quimioterapia no modificaron la probabilidad de desarrollar hipotiroidismo. El sexo demostró un valor predictor (un 66,6 frente a un 25,8% en mujeres y varones, respectivamente; p < 0,05). La tasa de incidencia de hipotiroidismo después de radioterapia en pacientes con cáncer de cabeza y cuello es elevada. Es importante determinar la TSH durante un largo período de tiempo después de la radioterapia. Radiotherapy in the treatment of cancer of the head and neck can cause hypothyroidism. Our aim was to study the development of thyroid hypofunction in these patients. We performed a retrospective analysis of 194 patients who underwent radiotherapy for head and neck cancer. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were determined at 3, 6 and 12 months after radiotherapy and then annually during follow-up. Hypothyroidism was classified as subclinical (SHT) (an increase of TSG and normal FT4 levels) and clinical (CHT) (an increase of TSH and a decrease of FT4). The association between hypothyroidism and age, sex, histological type of the tumor, radiation dose and use of chemotherapy was analyzed. With a mean follow-up of 4.2 years, 56 patients showed elevated TSH levels (SHT in 39 patients and CHT in 17). The mean time to diagnosis was 3.0 ± 1.8 years (SHT 2.6 ± 1.5 years, CHT 4 ± 1.9 years; p < 0.05). Eighty percent of the patients were diagnosed between the second and the sixth year after radiotherapy. Age, histological type, radiation dose and use of chemotherapy did not affect the probability of developing hypothyroidism. Sex had a predictive value (66.6% in women versus 25.8% in men; p < 0.05). The incidence rate of hypothyroidism after radiotherapy in patients with cancer of the head and neck is high. Prolonged follow-up of TSH levels should be performed in these patients after radiotherapy.

Introduction: The treatment of nasal valve dysfunction is very controversial and many otorhinolaryngologists do not always take surgery into consideration. The purpose of this paper is to present the author's surgical technique and the description of 13 patients on which it may work.Material and method: Thirteen cases presenting with nasal obstruction secondary to nasal valve dysfunction are reviewed. All of the patients presented with internal valvulary incompetence and in three of them an alar collapse was associated. Diagnosis was achieved by means of the clinical findings and physical examination. An open rhinoplasty approach was employed. The surgical technique consisted in a transposition of the Upper lateral cartilage over the alar cartilage. In the three patients with alar collapse a fixation graft from the septal cartilage was also employed.Results: Nasal obstruction and valvular incompetence seemed improved in all of the cases.Conclusion: Upper lateral cartilage transposition seems to be an adequate method to solve the nasal valve incompetence.

Delayed flaps include surgical techniques performed in order to diminish the blood supply of a flap before placing it at the definitive location. The purpose is to improve the irrigation of the distal region of the flap. Three cases of head and neck reconstructions with delayed deltopectoral flaps are reported. Literature about anatomic and physiologic phenomenon occurred during the delay period is reviewed, as well as the different surgical techniques described to delay a flap. We think that the deltopectoral flap remains an adequate technique, being indicated when the reconstruction is impossible with local flaps. That is the case of defects or irradiated regions. In our opinion, if the deltoid region of the flap is necessary to the reconstruction it is recommended to delay the flap, to increase the probability of complete survival at the distal region. In our cases the delay period has been one week, obtaining a complete survival of the flap in all of them.

The resection of malignant tumours affecting the upper lip, columella, premaxilla and/or caudal septum requires reconstructive surgery, which does not always produce satisfactory results—either aesthetic or functional. We have designed a modification of the Abbé flap consisting of the extension of the distal portion of the latter over the chin, and the inclusion of a fragment of rib cartilage in this portion of the flap. The columella is reconstructed in this way, and the cartilage serves to buttress the pyramid tip and prevent its collapse. A case is reported, with good aesthetic and functional results. Other surgical procedures are discussed, analysing their advantages and inconveniences.

Laryngeal carcinoma is the most frequent malignant tumour in head and neck. Node invasion is known to be one of the most important prognostic factors. The aim of this study has been to design an intelligent system to perform a diagnostic algorithm of metastasic neck nodes. 122 clinical reports of patients diagnosed of laryngeal carcinoma in our department have been reviewed. The compiled data have been: tumor site, T stage, N stage (clinical, after CT scan and post-surgery). The method used to design the intelligent system has been the ID3, which is able to generate a minimal decision tree. Palpation has been the variable that has given more information about node invasion. CT has proved to be more efficient in supraglottic tumours. ID3 method has shown to be useful in performing diagnostic algorithms, specially when the number of cases and diagnostic tests are high.

El cáncer de laringe es el tumor maligno de cabeza y cuello más frecuente. La invasión ganglionar es uno de los factores que más influye en el pronóstico de esta patología. El objetivo de este trabajo ha sido diseñar un sistema inteligente capaz de elaborar un protocolo diagnóstico de adenopatías metastásicas. Se han revisado 122 historias clínicas de pacientes diagnosticados de cáncer de laringe en nuestro servicio. Los datos recopilados han sido la localización tumoral, el estadio T y el estadio N (clínico, por TC y postcirugía). El método utilizado para elaborar el sistema inteligente ha sido el ID3, capaz de generar un árbol de decisión mínimo. La palpación ha sido la variable que mayor información ha aportado al conocimiento de la invasión ganglionar. La TC se ha mostrado más eficaz en los tumores supraglóticos. El método ID3 es útil para la elaboración de algoritmos diagnósticos, sobre todo cuando el número de casos y la cantidad de pruebas diagnósticas son elevados.

Repeated treatments on the neck in head and neck oncological patients make more and more difficult to elaborate microvascularized flaps because sometimes it is necessary to sacrifice receptor veins. In this paper it is showed one way of solving this problem, by dissection of the cephalic vein towards the deltoid region, keeping the venous pedicle intact. In this fashion venous anastomosis is avoided, getting efficient blood drainage. Simplicity and efficiency of this technique make possible thinking about it even with existing receptors veins. The main inconvenience is the surgical scare on the anterior region of the arm.

Los sucesivos tratamientos sobre el cuello en el caso de los pacientes oncológicos cérvico-faciales dificultan la práctica de colgajos microvascularizados porque en ocasiones conllevan el sacrificio de los potenciales vasos receptores. Presentamos un caso en el que este problema fue resuelto mediante la disección retrógrada de la vena cefálica hasta la región deltoidea, manteniendo intacto el pedículo venoso. Con ello se evitó la anastomosis venosa, consiguiéndose un drenaje sanguíneo eficaz. La sencillez de la técnica y su eficacia permite planteársela incluso ante la existencia de venas receptoras. El principal inconveniente es la cicatriz en la región anterior del brazo. Repeated treatments on the neck in head and neck oncologycal patients make more and more difficult to elaborate microvascularized flaps because sometimes it is necessary to sacrifice receptor veins. In this paper it is showed one way of solving this problem, by dissection of the cephalic vein towards the deltoid region, keeping the venous pedicle intact. In this fashion venous anastomosis is avoided, getting efficient blood drainage. Simplicity and efficiency of this technique make possible thinking about it even with existing receptors veins. The main inconvenience is the surgical scare on the anterior region of the arm.